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There has been a steady, inexorable decline in Ireland’s health service over the past fifteen years, writes Dr Tom Clonan.

SIMON HARRIS SAYS he is ‘ashamed and heartbroken’. After watching last night’s RTE Investigates documentary I too am heartbroken – and frightened. I’m frightened most of all by Simon Harris’s shocking lack of insight into the inevitable outcome of his own party’s policies in government. As a parent of a sick child, his statement of ‘shame’ reads like an alternative fact.

I have four children. Three boys and a girl. One of my sons has a rare neuromuscular disease and is a wheelchair user. The neuromuscular disease has attacked the motor function in his legs, arms, hands and fingers. It has also compromised his eyesight. Over his short life, Eoghan has undergone countless investigations, examinations and therapies at the hands of our frontline medical staff in the Central Remedial Clinic and Temple Street Children’s Hospital.

Tom with his son Eoghan

The HSE frontline staff that we interact with – from receptionists, to porters, to nurses, from clinical nurse specialists, to doctors and consultants – are, without exception, the most hardworking, caring and dedicated professionals you will ever meet. In their interactions with Eoghan, from physiotherapy to occupational therapy, surgical review, neurology – the seemingly endless range of specialties and disciplines required to manage his disease – the staff are gentle, kind, good-humoured and treat our son as best they can within the growing shortages of staff and resources that beset our health service.

This is not the fault of frontline staff

Today is Eoghan’s birthday. He is fifteen years old. Over the last fifteen years, we have seen a steady, inexorable decline in the staff numbers and resources available to Eoghan. This deterioration in our health services accelerated dramatically around the time of the bank bailout, where precious public funds were funneled away from health to service the €85 billion banking debt imposed upon us by successive governments and the Troika.

Post-crash, the austerity policies pursued relentlessly by those in government have made things progressively worse. I have written consistently in TheJournal.ie and elsewhere over the last number of years of the near total collapse in those vital therapies available to children such as Eoghan.

In the last two years, Eoghan has developed a scoliotic curve to his spine. At 15, it causes him some distress and some pain. At the time of writing he is not yet a candidate for surgery. In January, we had an appointment in Temple Street Hospital. In all the years I have been attending the hospital, I have never before seen the sheer number of sick children and parents in attendance on that grey morning. After circling the hospital several times in a desperate search for a parking space – a routine familiar to the parents of sick children – we eventually gained access to the ground floor outpatients department. In a scene that was reminiscent of a hospital in the developing world, it was so crowded there that we had to enlist the assistance of a porter to clear a path through the press of humanity so that Eoghan’s wheelchair could pass by. This, I repeat, is not the fault of frontline staff.

Such overcrowding – like the homeless crisis and other crises throughout our public services – is a symptomatic outcome of the policy decisions taken at cabinet since 2011 by Taoiseach Enda Kenny, Minister James Reilly, Minister Leo Varadkar and now, Minister Simon Harris.

Who is to blame?

Monday’s excellent documentary by RTE Investigates revealed the appalling plight confronted by tens of thousands of children and adults throughout the state who are on waiting lists for surgery. The documentary revealed a health service that is chronically under-staffed and poorly resourced – leading to the most heartbreaking suffering endured, unnecessarily, by Irish children and adults alike.

So – who is to blame? Frontline medical professionals, doctors, nurses and their representative groups have been saying for over a decade what families like mine know – there are not enough doctors and nurses. There are not enough beds in our hospital system. The health service is short by about 2,000 beds. The lack of medical staff and beds leads inevitably to the delays, deferred surgeries and human suffering highlighted by the national broadcaster last night. It is not rocket science.

However, the documentary also reveals that the figures around waiting lists have been manipulated in order to conceal the real problems within the health service. In recent years, successive Irish governments – and in particular, their highly paid special advisors and a growing army of politically appointed spin doctors – have led the way with ‘alternative facts’ and ‘fake news’ about our badly resourced public services. Through hundreds – perhaps thousands – of expensive reports, reviews, investigations, action plans, and an endless cycle of press conferences, our Ministers and their apparatchiks have made a new rocket science of distorting the reality of their austerity policies. Irish government spin doctors can probably claim the credit for being the first administration to create a post-factual public discourse. They’ve trumped Trump himself.

In this perverse alternative reality, Minister Harris has employed precisely the same rhetorical devices as his predecessor Leo Varadkar in order to deflect criticism and to evade responsibility for the crisis in our health services.

The government should take responsibility for its actions

First of all, as was Minister Varadkar’s habit, Harris automatically seeks to blame the HSE. ”It is about the HSE who are in charge of operations. They are the ones responsible for delivering our health service”. No, Minister Harris, that is not quite correct. You as Minister may delegate authority to the HSE to run services – but you cannot delegate responsibility. You are responsible for the crisis.

As a parent of a sick child who is floundering in a failing health service, Minister Harris’s assertions of heartbreak and shame ring hollow. Like his predecessor Minister Varadkar, Harris mobilises the same glib, patronising and cynical language used by his Cabinet colleagues to distance himself from the crisis in health. His remarks have a bizarrely detached quality to them, as though this foreseeable and predictable crisis were nothing to do with him, outside of his control and that of his cabinet colleagues. In his Kafka-esque world, the Minister for Health is not actually responsible for Health, but is actually surprised and shocked by the inevitable consequences of his actions and those of his Cabinet colleagues.

I have no doubt that in the coming days, the government’s special advisers and media advisers will place information and reports on the news agenda that will seek to shift the blame for the current crisis on the HSE – or their other favourite target – hard-pressed doctors and nurses.

We saw this evening that Minister Harris announced a new operating theatre will open in April at Crumlin Children’s Hospital for the treatment of scoliosis, and a HSE action plan on scoliosis will be delivered by the end of this month.

Whatever the shift in focus, I would make one simple appeal to Minister Harris. I would ask him to make one simple decision that would redeem his failings in Health and mark an enduring and positive contribution to the health of our seriously ill children and young adults. As a parent of a sick child, I would plead with Minister Harris not to locate the new children’s hospital on the cramped St James’s site. I would ask him to locate it in the grounds of Connolly Hospital, Blanchardstown. If Minister Harris can get past his apparatchiks and advisors, he might hear the voice of reason. It would be one silver lining to the debate prompted by RTE Investigates and might represent a glimmer of hope on an otherwise bleak horizon.

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